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Carvedilol May Offer Therapeutic Potential In Cirrhosis
A DGReview of :"Randomized comparison of long-term carvedilol and propranolol administration in the treatment of portal hypertension in cirrhosis."
Hepatology
12/17/2002
By David Loshak
Carvedilol has a greater portal hypotensive effect than does propranolol in patients with cirrhosis. However, the its systemic hypotensive effects may limit its clinical applicability.
Investigators in Barcelona and Madrid, Spain, noted that while short-term carvedilol was more powerful than propranolol in reducing hepatic venous pressure gradient in cirrhotic patients, it induced arterial hypotension. That might prevent its long-term use in portal hypertensive patients, the investigators suggested.
To compare hepatic venous pressure gradient reduction and safety of the two drugs long-term, the researchers randomised 51 cirrhotic patients to receive either carvedilol (n=26) or propranolol (n=25).
Haemodynamic measurements and renal function were assessed at baseline and after 11.1 ± 4.1 weeks.
Carvedilol lowered the hepatic venous pressure gradient by 19 ± 2.0 percent. This was significantly more than propranolol (12 ± 2.0 percent).
More than half (54 percent) of patients given carvedilol achieved hepatic venous pressure gradient reductions of 20 percent or more or of 12 mm Hg or less. Fewer than a quarter (23 percent) of propranolol recipients achieved such reductions.
Carvedilol caused a statistically significant decrease (11 ± 1.0 percent) in mean arterial pressure whereas the decrease with propranolol was not significant (5 ± 3.0 percent).
Carvedilol also led to statistically significant increases in plasma volume (11 ± 5.0 percent) and body weight (2 .0± 1.0 percent).
Glomerular filtration rate did not change with either drug. The dose of diuretics was increased more often after carvedilol (27 percent) than after propranolol (8.0 percent). Adverse events caused two patients receiving carvedilol and three patients receiving propranolol to discontinue treatment.
The investigators said that further trials were needed to confirm carvedilol's therapeutic potential.
Hepatology 2002;36(6):1367-1373.
"Randomized comparison of long-term carvedilol and propranolol administration in the treatment of portal hypertension in cirrhosis."
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